An interaction with a patient the other day brought to mind some thoughts that I would like to share.

Many people today are much more in tune with alternative medicine and alternative therapies to remedy health conditions. My colleagues and I often will inquire to a patient regarding taking any supplements but often times these are not disclosed. The patient thinks that there wouldn't be any reason that a dentist would need to know about a herbal supplement that they are taking. It may be that the patient is fearful that the dentist would not look approvingly upon the patient's choice to pursue alternative therapies rather than conventional Western medicine.

Knowing my colleagues in this area, I could assure a patient that this wouldn't be a concern and please do tell your dentist about any and all medicines or supplements that you are taking. I would like to give a few examples of how these supplements have dental effects that our patients may not have thought of.

The first supplement I'd like to mention is apple cider vinegar. A patient came to see me because she was concerned that her gums were receding on the outside of the lower teeth. She also complained that these teeth were very sensitive. An examination of her mouth disclosed receding gums on the lower back teeth which hasn't been present before. This is a regular patient who has extremely healthy gums. A discussion with this patient revealed that she had recently started taking apple cider vinegar. This is a supplement that is taken for many health benefits including cholesterol reduction, weight loss, arthritis relief and as a treatment for fungal infections among others. Apple cider vinegar also is extremely acidic. This low pH causes rapid breakdown of tooth structure and of thin gum tissue layers like was seen in this patient.

Another supplement that is commonly used is Ginkgo Biloba. Ginkgo is regularly used as a supplement to slow memory deterioration and to improve mental faculties. This has the side effect of being a powerful anticoagulant. Anyone that is on any type of blood thinner should not take Ginkgo. The dental implications come when a patient might need a tooth extracted. It is recommended that Ginkgo be stopped 2-3 weeks before any surgery. This includes dental surgery. Any tooth extraction, implant placement or periodontal therapy would be delayed if a patient were on Ginkgo.

Ginger is a supplement which is used mostly as an anti-emetic to settle an upset stomach. Ginger falls under the same precautions as the Gingko above in that it can interfere with clotting of the blood and can interfere with high blood pressure medicines. It too, should be stopped 2-3 weeks before any dental or other surgery.

Another complication that is seen with certain herbal supplements is an interaction with the epinephrine which is in most anesthetics. The epinephrine in our local anesthetics helps to keep the anesthetic in the area by the nerve to get good numbness. Certain herbal supplements will enhance this epinephrine and can cause a sudden change in blood pressure. A person with blood pressure problems could be in a real crisis.

Hopefully I have made the point that yes, it is important that any and all medications, supplements and vitamins be disclosed to your dentist. We are health care providers who are gatekeepers of the oral cavity.

By giving all the information to us, we can be sure to keep up our end of having our patients as healthy as they can be.

Dr. Michael K. Keating, DDS, is a dentist in Auburn and can be reached at 252-7278 or e-mail him at DrMike@FingerLakesSmiles.com